DEPARTMENT OF HUMAN SERVICES
DIVISION OF FAMILY DEVELOPMENT
CONTRACT ADMINISTRATION UNIT
CONTRACT RENEWAL PACKAGE
FY 17 Technical Assistance (TA)
FY 17 TA Renewal Instructions and Deadlines
Important Deadlines and Reminders:
1. The renewal package must be submitted to the DFD Contract Administrator
before July 1, 2016.
2. Any renewal contract package not received by July 1 will risk forfeiture of the
contract award.
3. DFD will not authorize any service without the timely receipt of a contract
renewal package. Until final DFD approval of the scope of work detailed in the
Annex A, DFD assumes no liability for the services rendered and the costs
incurred.
4. Any contract not submitted in accordance with the instructions and within the
timeframe required or failure to respond to all requests for additional
documentation that prevents the execution of the contract before October 30, 2016
will result in rescission of the contract award.
5. The renewal package submitted must be the FY 17 package and forms.
Reminders for FY17
The Annex B must include a written, detailed budget narrative explaining the
proposed costs included in the budget. The narrative should explain all proposed staff
and costs in the budget and how the costs were estimated.
Specific comments regarding proposed program staff, subcontractors, vendors, and
consultants, indirect cost rates (including fringe benefits and General and
Administrative (G&A) must be included in the narrative. The narrative should
explain the source(s) of funding when the DFD contract is not the sole source of
funding for the program.
The Annex B and narrative should include details of all fringe benefits, indirect cost
pool, indirect cost base, and allocation methodology for the allocation of the indirect
costs.
DFD must easily understand the total proposed budget and identify what services are
being provided and at what cost – both direct and indirect. The budget should be
very detailed and include specific proposed costs for all expenditures (office
supplies, travel, provider training, staff development training, postage, printing,
meeting expense, conference, mileage, etc.). The budget narrative should then
explain the purpose of each expense included in the proposed budget, how the
cost was estimated (i.e. number of trips/mileage to be reimbursed at $.xx per
1
mile) and also include commentary on the purpose for the expense and explain
the relationship to the delivery of service and accomplishment of the program
goals and objectives.
Annex A Reminders:
The Annex A consists of two parts; Part I is the written narrative that must be thorough
and include specific details of the program services, manner and method of delivery
including program services, client eligibility, subcontractor and/or vendors that will
provide services. The narrative should include commentary regarding the client universe,
eligibility factors, determination methods, documentation and level of service to be
provided. This requires a detailed discussion for each service component, including
vendor, projected level of service to be provided, number of clients, rates and total cost.
The information detailed in the narrative must reconcile to Projected Level of Service
(LOS) reports –as applicable - as part of the renewal package. Part II requires a response
to the questions.
Please make sure all mathematical computations in the projected LOS are correct.
The lack of details and incorrect data in the Annex A and LOS prevent the timely
approval of program services and will delay the approval of the contract. Any contract
not submitted in accordance with the instructions and the timely manner required or
failure to respond to all requests for additional documentation that prevents the execution
of the contract before September 30, 2016 will be rescinded.
Subcontract agreements should be submitted to DFD and approved before the start
of the contract, but are due to DFD no later than August 1. Failure to submit and
obtain approval will result in disallowed costs and risk of reduction in the contract
ceiling.
Annex B Reminders:
All budgeted costs must adhere to the DHS cost principles contained in the DHS Cost
Reimbursement Manual – specifically Section 4. DFD will review the budgeted costs for
allowability, allocability and reasonableness.
Proposed administrative costs must meet the cost principles contained in the DHS
contract manuals and should not exceed 12% or the administrative cost outlined in the
award letter.
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DEFINITION OF ADMINISTRATIVE COSTS
In accordance with the Final Temporary Assistance for Needy Families (TANF)
regulations, specifically 45 CFR Part 263.0(b), administrative costs include and exclude
the following:
ADMINISTRATIVE COSTS INCLUDE:
Administrative costs are those expenses necessary for general administration and
coordination of TANF (including indirect and overhead), including:

Salaries and benefits of staff performing administrative and
coordination functions;

Activities related to eligibility determinations;

Preparation of program plans, budgets, reports, schedules
and other documents;

Monitoring of programs and projects;

Fraud and Abuse units;

Public relations;

Services related to procurement, accounting, litigation,
audits, property management and personnel;

Management Information Systems not related to the
tracking and monitoring of
TANF requirements (e.g., payroll and personnel systems for staff administering TANF);

Costs for the goods and services required for administration
activities mentioned above) of TANF, such as:
(e.g.,
 Supplies
 Equipment
 Travel
 Postage
 Utilities
 Office space
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ADMINISTRATIVE COSTS EXCLUDE:

Direct costs (salaries, benefits, related direct administrative costs) of staff
providing program services, such as:
 Providing Early Employment Initiative (Diversion)
funding
 Providing program information to clients
 Screening and assessments
 Development of Employability Plans
 Work activities
 Post-employment services (e.g., child care and
transportation)
 Work supports
 Case management
All costs for contracts devoted entirely to the above services.
Please note the special contract terms for:
Salary – See SLD P2.01, Sections 5.16 and 5.17
Conferences/Meetings – See SLD P2.01, Section 5.22 and CRM Section 4.6 (requires 30
days pre-approval)
Travel – See SLD P2.01, Section 5.20 and CRM Section 4.6
Subcontracts – See SLD P2.01, Section 5.02, CRM Section and DHS Policy P99.2
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ANNEX B - Helpful Hints
Detailed instructions for completing the Annex B including the DHS Cost Reimbursement
Manual (CRM), Section 5.3 and an Annex B tutorial are located at
http://www.state.nj.us/humanservices/dfd/info/
The budget should detail all costs to administer program and meet program goals and
objectives in accordance with required cost principles and instructions of the CRM.
The budget must:





Be prepared in accordance with GAAP and reflect an agency-wide budget
Include details of all other grants/contracts and specify those also contributing
towards funding the program
Specify all proposed costs as direct or indirect
For all indirect costs - identify the indirect cost basis of allocation
Detail all subcontract/vendor services
Have two (2) original signatures on the summary page
Copies of consultant and subcontract agreements must be submitted
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Other Important Reminders
Required Documents: (DHS Policy P1.01)
All required contract documents, forms, signatures (original) with the required number of
copies and signatures must be returned.
Modifications: (DHS Policy P1.10) (final request due to DFD no later than 5/15/17)
Reporting: (Detailed in the Annex A and SLD Section 3.02)
Contract Acquired Equipment and Disposal: (DHS Policy P4.05)
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Contract Renewal Package
Annex A:
Contract Summary Sheet
Authorized Signatures
Service Delivery Information
Part I - Program Narrative
Part II – Questions
Projected Level of Service – if required
Renewal Documents:
Index of Required Contract Documents
Contract Checklist
Document Verification Sheet (DVS)
Executive Order 129
Certification of Suspension and Debarment
FAFTA
Disclosure of Investment Activities in IRAN
List of Contracts/Grants
Contract Forms (List of Required Documents Available on DFD Website)
Federal Award Information
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ANNEX A-Forms Instructions
Contract Summary Sheet
Enter all data requested in the form. Enter Agency Official responsible for the program
administration.
Authorized Signatories
Enter Authorized Signatory for the Contract (as authorized by Agency Bylaws or Board
Resolution).
IMPORTANT - This is the address where the signed contract and all relevant legal
correspondence will be mailed – so please ensure this is the accurate address.
Service Delivery Information
Please complete all details for the service delivery
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STATE OF NEW JERSEY - DIVISION OF FAMILY DEVELOPMENT
ANNEX A – CONTRACT SUMMARY SHEET – FY 17TA
Contract
TA
#
Federal
IIIDI
D#
Provider Agency
Mailing Address
Telephone
Number
Provider Agency Fiscal Year End
Contract Effective
Date
Organization
Type
Agency
to
Contract $
Ceiling
Agency
Board of Social
Services
CWA
Non-Profit
TA Program
AAdminsitation
Details:
Agency Official
Executive
Title Officer
Mailing Address
Telephone
Number
Fax Number
E-Mail Address
All routine notices relevant to the administration of the program should be sent to:
Name & Title
Mailing Address
Telephone
Number
Fax Number
E-Mail Address
Do you currently receive payment by Automatic Deposit (ACH) for this contract?
Yes
No
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Division of Family Development
Annex A - Authorized Signatures – FY 17 TA
List names and positions of persons authorized to sign the following and number of persons
required to sign each transaction.
Name/Address
Position
# of Signatures
Required
1
Contract
2
3
1
Quarterly and Final2
Financial Reports
3
1
Contract
Budget Modification
2
3
1
Checks
2
3
Other Contract 1
Documents: Program
2
Reports
3
Note: - Enter Authorized Signatory for the Contract (as authorized by
Agency Bylaws or Board Resolution). This is the address where the signed
contract and all relevant legal correspondence will be mailed. This should be the
individual who signs the SLD (page 23). This may not be the same individual as noted in
the Annex A summary sheet. In the event of emergency notification, please include e-mail
and fax number.
Contract Signatory
Title
Mailing Address
Telephone Number
Fax Number
E-Mail Address
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Contract #
FY 17 TA
Division of Family Development
Annex A -Service Delivery Information
Program Name:
Site Address:
City, State, and Zip
Site Phone Number:
Program
Director/Coordinator
Telephone #:
Fax:
E-Mail:
Service will be provided as follows (designate time):
From
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
To
Services will not be provided on the following occasions: # Holidays _______
Date (s)
Occasion
Emergency Provisions: Describe any special arrangements which have been made to handle emergencies,
e.g.
voice
mail
instructions,
etc.:_________________________________________________
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special
telephone
numbers
Division of Family Development
ANNEX A - PROGRAM OPERATIONS
Introduction and Instructions:
Following are the contract components to be administered for the program. The Provider
Agency shall describe the components as they are administered internally. The Annex A,
Program Description information should reconcile to the projected Level of Service (LOS) data
and reconcile to the details included in the Annex B - Budget.
The Provider Agency must provide information in the Annex A narrative describing how each
service component of this contact will be administered including internal processes and controls
for each program/service component. Answer all questions by providing information that is
quantifiable and qualifiedly measurable to the extent feasible.
Key Statutory and Regulation Requirements of the contract
a. Determine who is eligible to receive Federal and State financial assistance;
b. Have internal controls and performance measures to determine that all Federal and State
rules are accurately applied;
c. Adherence to applicable Federal rules and State program compliance requirements; and
d. Assurance of appropriate use of allowable government funds to carry out the goals and
objectives of the program.
The Provider Agency assures that it will comply with the following statutory requirements and
ensure Federal and State funds are applied to:
Eligible Clients – By statue – only clients that meet program eligibility criteria
Staffing - The agency agrees that a minimum it will provide notification of any program
administration staff changes to the DFD Contract Administrator and Program Representative
within 20 days of the change.
Personnel Requirements
The Agency Director or program designee must attend and participate in DFD-sponsored inperson meetings and trainings and conference calls as directed by the DFD Contracts and
Program Staff.
Fiscal Standards and Accountability
Recipients and sub-recipients of Federal and State funds are responsible for the proper use of
such fund. Funds must only be used for the intended purpose and in compliance with all Federal,
State and contract regulations. All parties are responsible for the transparency and accountability
for the funds and are subject to administrative, contractual and legal sanctions for the misuse
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and/or improper use of these funds. Provider Agencies are considered sub-grantee/recipients
under this contract and are subject to Federal laws, regulations and provisions of this contract as
set forth in this document; and must ensure adherence to all applicable regulations.
The agency must meet all contract expectations as described in the RFP as well as those detailed
in this contract. Failure to meet any performance standard and contract expectations can be
grounds for revision of the contract whereby current funding is reduced, contract is suspended or
terminated and can affect future consideration for funding.
In addition to the core areas of program delivery, Provider Agencies must maintain
administrative and fiscal accountability, meet reporting requirements, and ensure program
integrity to meet all program compliance and performance standards. As recipients of
government funds, all agencies must adhere to all federal and state laws and regulations as stated
above.
Grant Cost Principles – Costs incurred for the delivery of the services will be based on Federal
and State cost principles and include only those costs deemed allowable, allocable and
reasonable per the regulations.
Fiscal Requirements:
The agency is a third party provider of services to DFD subject to administrative, fiscal and
programmatic monitoring and oversight from DFD. The provider agencies are responsible to
adhere to all DHS and DFD contract rules and regulations and to follow all directives issued by
DFD. Provider Agencies’ acceptance and use of Federal and State funds from this contract
constitutes the agency’s acceptance of these terms and conditions.
Recipients and sub-recipients of Federal and State funds are responsible for the proper use of
such funds. Funds are used for the intended purpose and in compliance with all Federal, State
and contract regulations. All parties are responsible for the transparency and accountability for
the funds and are subject to administrative, contractual and legal sanctions for the misuse and/or
improper use of these funds. Provider agencies are considered sub-grantee/recipients under this
contract and are subject to federal laws, regulations and provisions of this contract as set forth in
this document and must ensure that:






Contract funds are allocated to meet program objectives and for the purpose as intended;
Fiscal and accounting procedures are sufficient to permit the preparation of required
reports and the proper reconciliation of expenditures to adequate source documentation to
establish funds have been used appropriately for the intended purpose in accordance with
all applicable laws, regulations, and contract cost principles;
Annual completion of the Single Audit, as required;
Funds are not used to support inherently religious activities, such as religious instruction
or activities;
Funds are not used to support lobbying activities to influence proposed or pending
Federal or State legislation or appropriations; and
Funds are expended in accordance with all pertinent laws and regulations.
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Allowable Cost
The determination of allowable costs is defined in the SLD, RFP, DHS and DFD Cost
Reimbursement Manual (CRM) and the DHS Contract Policy and Information Manual (CPIM).
Expenditures are defined as those costs which are restricted to activities related to programmed
plan development; complaint files management; public hearing information; program monitoring
and coordination; report preparation; evaluation of program outcomes; personnel management;
travel; equipment; supplies; audits and response management; and indirect costs such as
maintenance of facilities, utilities, and general management staff.
Reporting Requirements
The agency is required to submit program and fiscal reports within the required timeframes. At
a minimum, the following reports are required:
I.
A.
Fiscal Reports
Report of Expenditures (ROE)
Fiscal reporting is required on a quarterly basis combining subcontracted and direct agency
expenditures. Actual expenditures must be reported using the Annex B form on a cumulative
basis by the 20th day of the following month after the close of each calendar quarter.
The Final ROE is due 120 days after the contract period ends.
The expenditure reports must contain an original signature of the CEO and fiscal officer
designated by the agency for this program.
An initial advance payment will be issued when the contract is fully executed. Future quarterly
reimbursements will occur subsequent to DFD’s receipt and review of the expenditure report for
the previous quarter and as long as all other contract deliverables are met.
All reports must be sent to:
DFD, Office of Contract Administration
P.O. Box 716
Trenton, New Jersey 08625-0716
Attention: Contract Fiscal Unit
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II.
Program Reports
Program reports are to be submitted to the DFD Program Office as specified in the Annex A.
III.
Payment Terms
The initial advance payment representing 25% of the contract ceiling will be issued when the
contract is approved and signed. Subsequent quarterly advance payments are issued upon receipt
and review of the quarterly report of expenditures (ROE) and, assuming all other contract
obligations are current and there are no violations of any other contract provisions. Adjustments
to a quarterly payment may be made for a variety of reasons, including provider agency spending
patterns, DFD fiscal review issues, audit matters that come to our attention, or as needed to meet
program delivery and DFD Budget/ Fiscal issues.
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Division of Family Development
FY17 TA Annex A-Part I Narrative
BACKGROUND:
The New Jersey Department of Human Services (DHS), Division of Family Development
(DFD), provides resources and supports to address the child care needs of families and support
providers and programs servicing families that need early care and education services. With the
implementation of Grow NJ Kids, New Jersey’s Quality Rating and Improvement System
(QRIS), NJ is: broadening awareness of the components of quality and is helping to benchmark
quality for consumers; providing additional incentives and resources to programs and is creating
a stronger infrastructure to support and sustain the quality of programs, regardless of the setting.
In April 2013, NJ DHS in partnership with other state agencies (Department(s) of Education,
Children and Families, and Health), piloted a quality rating and improvement system called
Grow NJ Kids in four New Jersey counties. In January 2014, New Jersey was awarded the Race
to the Top Early Learning Challenge (RTT-ELC) grant which expanded Grow NJ Kids
statewide.
Though The NJ Department of Education is the lead Department for the grant, all four state
departments mentioned above are partners. To support the statewide expansion of Grow NJ
Kids, the state has created four (4) regional technical assistance centers that serve to help support
and strengthen the quality of Grow NJ Kids programs.
Core functions of the RTT-ELC are to (1) build a comprehensive Early Care and Education
System, (2) align early learning standards and (3) implement an accountable and transparent
quality improvement system (Grow NJ Kids). The Department of Human Services, Division of
Family Development, along with its collaborative partners, has a unique opportunity to bolster,
fully support and help programs successfully improve the quality of their programs. New Jersey
is one (1) of thirty-nine (39) states that has implemented a research based QRIS to improve and
communicate the level of quality across early care and education to support and strengthen early
learning programs, and provide families with an easy way to recognize high quality programs
and providers.
Technical Assistance is a critical component of the Grow NJ Kids quality improvement system
and a key strategy to help improve quality in early care programs and Family Child Care
settings. Aligning TA services, within Grow NJ Kids, along with other quality activities are
essential to the success of programs meeting Grow NJ Kids and higher standards; especially
because providers enrolled in Grow NJ Kids are diverse, have individual needs and will be
entering the process in different stages of implementation.
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Grow NJ Kids Enrollment and Coordination Process
All programs enrolled in Grow NJ Kids will be assigned a Quality Improvement Specialist (QIS)
based on their program type (i.e. childcare, district funded programs, Head Start) in their
county/region, who will work closely with the TA Center. QIS will help programs and providers
go through the first steps in the Grow NJ Kids process and provide targeted technical assistance.
Part of Grow NJ Kids eligibility process is first enrolling in Grow NJ Kids by registering with
Professional Impact New Jersey (PINJ) and submitting an enrollment form. After the program
completes the Grow NJ Kids Director’s Orientation, the QIS will be responsible for helping to
ensure the program staff are enrolled in PINJ registry. Therefore prior to transitioning to the
technical assistance centers, programs and providers will first enroll and participate in Director’s
Orientation, enroll appropriate staff in Professional Impact NJ (workforce registry), health and
safety review, orient program/provider staff to the Grow NJ Kids process, initial data gathering,
and complete 2 classrooms or 3 % (whichever is greater) classroom observations using the
appropriate Environmental Rating Scale respective.
After the completion of orientation and initial steps of Grow NJ Kids, as described above, the
QIS will transition the program to the TA center to begin providing intensive technical assistance
(TA). Recognizing the diversity of providers, a Tiered TA approach will be utilized to meet
programs where they are to provide individualized and targeted TA services.
PROGRAM GOALS
The overall goal is to implement a statewide comprehensive Technical Assistance System to
support the implementation of Grow NJ Kids. Grow NJ Kids is a critical component of New
Jersey’s Early Care and Education System designed to increase the quality of the early care and
education system for all children in New Jersey and to communicate effectively to parents
regarding the services their children are receiving.
Technical Assistance Systems must have presence in the region in which they are serving to
ensure that programs and providers have easy access to TA services. Technical assistance staff
members will work with Grow NJ Kids Programs across all sectors of early care and education
(i.e. Family Child Care, Head Start, Child Care, District funded Preschool) to help them reach
their quality goals, enhance health and safety standards, implement early learning guidelines, and
promote consumer education about quality.
In addition to providing technical assistance services, the project entails coordination and
collaboration with other key stakeholders, as well as identifying and sharing research-based
promising practices to address early childhood-related, cross-sector system issues and to identify
knowledge gaps and best practices.
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PURPOSE FOR TECHNICAL ASSISTANCE:
In alignment with best practices and national models, the Technical Assistance (TA) service
model is designed as an integrated TA system to support programs across all early childhood
settings, including Family Child Care Providers. The ultimate goal of a coordinated and
integrated TA system is to ensure that early childhood practitioners are highly effective in
supporting the development and learning of every child attending programs participating in
Grow NJ Kids.
Grow NJ Kids is a systematic approach to improve and communicate the level of quality across
early care and education programs using research based quality indicators to enhance, support
and strengthen early learning programs.
These Technical Assistance (TA) Administrative Services include but are not limited to:
1.
2.
3.
4.
5.
Technical Assistance
Evaluation Support Activities for Child Care and Family Child Care Programs
Coordination Activities with key stakeholders
Incentives Support and Ordering
Monthly, Quarterly and Annual Reports
SCOPE OF WORK:
Provider agencies are responsible for administering statewide comprehensive TA services to all
eligible programs and providers to help them continuously improve and meet Grow NJ Kids
quality standards.
TA services are provided in multiple formats including webinars, phone calls, email, an
interactive website portal, along with on-site visits and regional meetings.
The TA services are focused on Grow NJ Kids’ five quality standards major categories: Safe
and Healthy Learning Environment; Curriculum and Learning Environment; Family and
Community Engagement; Workforce/Professional Development; and Program Administration
and Management.
Provider agencies coordinate and collaborate with partners from Child Care Resource and
Referral Agencies-(CCR&Rs), school districts, Head Start, and other key quality provider
entities as deemed appropriate.
Trainings
It is expected that the provider agency participates in trainings as part of its role as a Technical
Assistance Provider. Trainings are aligned with DFD’s goals and mission of the TA statewide
service delivery system. Trainings will be provided either directly by DFD or designee.
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The provider agency may provide training but must coordinate with DFD when outside
consultants or subcontractors are utilized. Any training to be conducted by outside consultants or
subcontractors must be pre-approved by DHS/DFD.
It is expected that the provider agency assess and develop a training plan for staff to meet the
requirements of this contract.
Program Performance Reviews
The DHS/DFD owns all program information, forms, reports, records, data, data bases, data
code, data systems, computer programs, computer software, publications, presentations and/or
other work products as defined by DHS/DFD.
Technical Assistance Centers are required to collect, review and analyze program performance
data and send it to DHS/DFD (refer to the attached excel file, TA Performance Outcome
Reporting Document). Data should be recorded and submitted quarterly, electronically.
Subsequently, provider agencies will review, track, trend and provide documented quantitative
and qualitative feedback to the Grow NJ Kids programs on their performance outcomes.
Providers are required to use performance outcome data in monitoring the progress of the Grow
NJ Kids programs. Performance outcomes should be included in program site visit reports to the
Programs enrolled in Grow NJ Kids.
Continuous Quality Improvement (CQI):
All providers are responsible for reaching their expected outcomes as defined in the Annex A. A
process of corrective action will be implemented for underperformance. CQI is an essential
aspect of service delivery. Funded agencies must demonstrate progress in meeting established
program targets. The purpose of CQI is to ensure that DHS/DFD funded programs are effective
in reaching and supporting programs, and helping programs to achieve these core program
objectives. Through this process, grantees identify areas for performance improvement to reach
optimal levels of program functioning.
As part of the CQI process, underperformance in any area is reviewed to determine if a
corrective action plan is necessary and additional program data reports may be requested more
frequently. Revisions to mandated reporting requirements for the federally legislated benchmarks
will be issued in collaboration with all early care and education partners. All technical assistance
centers will be required to track and submit the required benchmark data as requested.
1. These targets continue to undergo review and analysis DHS/DFD Program Coordinator may
make further modifications to specific targets, or add additional indicators, after this analysis
is complete.
2. The CQI process will include input/consultation from all partners as the CQI processes will
be reviewed on a regular basis.
Reporting
Below is the list of the minimum required reports and performance outcome measures; additional
reports will be requested by DHS-DFD as needed.
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Quarterly Program Reports:
Program quarterly reports will include information on enrollments, level of service, site visit
completion, Self-Assessments, and Summary of Action Plans developed in partnership with
programs Technical Assistance, common needs, trends, best practices, latest research, data from
the program improvement plan and topics of those programs participating in Grow NJ Kids.
Summary of the baseline data collected during the initial site visits completed.
Bi-Annual Performance Outcome Measures:
The performance outcomes that are required to be submitted bi-annually:
Measures include, but are not limited to:
 Increase in Environmental Rating Scale Score

Curriculum Implementation

Programs movement through the Tiered TA process

Increase in the number of credentialed/degreed professionals

Number of programs who completed a Quality Improvement Plan
Annual Reports:

Completed Technical Assistance needs assessments and develop technical assistance plan
based upon the results.

Providers will conduct a satisfaction survey of the sites on Grow NJ Kids technical
assistance and training. The results and plan for improvement will be provided to
DHS/DFD as part of the applicant’s Continuous Quality Improvement Plan (CQI).
Evaluation Activities for Grow NJ Kids Programs:
All DHS/DFD funded providers must participate in the statewide evaluation and research study
being conducted by Rutgers University-National Institute for Early Education Research and any
other DHS/DFD approved research projects linked to funding requirements. DOE/OEC is the
lead state agency for the research evaluation for Grow NJ Kids and will collaborate with
DHS/DFD to determine the provider agency’s evaluation support activities.
All DHS/DFD funded programs must obtain prior written approval before engaging in any
research or evaluation projects that affect Grow NJ Kids, programs or existing research. All
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research projects are subject to DHS/DFD review, policies and procedures regarding research
evaluation.
Technical Assistance
Provider agencies are responsible for technical assistance of the Grow NJ Kids Programs in the
contracted region. At a minimum, Technical Assistance shall include the following::
1. Conducts a minimum of 6-12 onsite visits for each program (based on site need, quality
endorsement status, etc.)
a. Initial site visits will be conducted and recorded within the first thirty (30) of the
referral to the TA center.
b. Site visits will provide an extensive review of the program based on the Grow NJ
Kids standards and self-assessment. Visits will include follow-up to any plan of
action on areas identified that need improvement. ,.
c. Visits to programs should be scheduled in collaboration with other stakeholders when
appropriate. Site visit data much is captured and recorded in identified system.
2. Provide other forms of technical assistance such as peer to peer meetings at least 4 times per
year for each county in the region. These meetings should provide the opportunity for
Program Directors and Family Child Care providers to mentor each other to accomplish the
goals set to move through the Grow NJ Kids System. These can be in the form of face to
face, telephone or on-site.
3. Provide ongoing support through teleconference, email, etc.
4. Conduct bi-annual meetings based upon common needs/challenges so that programs can
learn from each other while also developing an increased norm of consistent practice
programs. This is an opportunity to keep programs that have been rated involved with the
Grow NJ Kids process.
5. Notify DHS/DFD of all critical incidents within 24 hours of being notified by the program.
The Provider Agency and DHS/DFD will conference regarding the follow-up needed
regarding the incident. Please note all staff associated with Grow NJ Kids are considered
mandated reporters of Child Abuse and Neglect and should follow the guides set by each
provider agency.
6. With assistance of DHS/DFD staff, facilitate ongoing relationships with collaborating
partners that include the local CCR&Rs, other State Departments, Professional Impact NJ,
and William Paterson University.
7. Technical Assistance Specialists will maintain the appropriate reliability thresholds for all
essential tools a part of Grow NJ Kids.
8. Technical Assistance Specialists will coach programs through the Strengthening Families
Self- Assessment and protective factor tools.
Committees
Community consultation is a crucial step to ensure that Grow NJ Kids services are effectively
responding to the perceptions and needs of the local communities. As such, a provider agency
representative will participate on the Local County Council and/or Central Intake Advisory
Board to promote integration of early childhood services and support the work of DCF/DFCP,
DOH/FHS, & DHS/DFD.
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Providers will align professional learning communities with the needs of the Grow NJ Kids
Programs. These learning communities should be documented and barriers and best practices
should be shared quarterly with the partnering Technical Assistance Centers and DHS/DFD.
These contracts for the TA services are awarded based on the April 2015 issuance of the
RFP and July 2015 contract awards. Refer to the RFP for a detailed description of the
tiered technical assistance, Scope of Work and other contract requirements.
22
Annex A - PROGRAM NARRATIVE
IMPORTANT Complete the Annex A and B and designated forms described in the DFD Contract
Award letter and renewal package. Please be sure that you are aware of all DFD contract and
subcontract requirements as a funded provider agency. All subcontracts must be approved by DFD and
include sufficient detail of the services; including scope of work, qualifications of consultant and
subcontractor, period of performance, compensation, etc. in the agreement. All contracts must include a
detailed budget narrative. Please submit the renewal package to the contract administrator as instructed
in the contract award letter
Section I: Write a brief, concise and descriptive summary of your program and services offered.
The description should present a clear picture of what, why, where, how, for whom, and as
applicable the frequency of services provided. At a minimum, have your summary respond to the
items/questions below.
1. Describe the goals, objectives, services/activities and performance outcomes of your agency’s
Technical Assistance system. Describe how your agency will meet the objectives, goals, and
deliverables detailed in the scope of work. Describe the performance goals for the DFD
program.
2. Identify and describe any unique capabilities of your agency in delivering the service.
3. DFD must approve the use of consultant trainers or subcontractors. Provide information about
the trainer’s experience with group training and the details of the proposed consultant.
4. Provide a description of the implementation plan of the contract’s activities/services detailed in
the scope of work. Describe the agency’s outreach efforts and communication efforts for the
DFD program.
5. Describe how program performance reviews and technical assistance impact/inform each other
to improve program operations, staff competencies and Grow NJ Kids outcomes.
6. Describe how your agency will use data as a management tool; how will outcome data be used to
inform program monitoring, technical assistance, Continuous Quality Improvement (CQI), site
visits, supervision, quality improvement plans.
7. Describe your agency’s progress performance goals/outcomes in the past year.
8. Identify any changes, challenges, limitations, restrictions, and priorities on service delivery and
how these challenges will be addressed during the next contract term.
9. Attach a calendar of trainings, site visits and other planned activities.
23
Section II: Please provide a narrative response to each of the following:
1. Describe your agency’s purpose, philosophy, goals, and objectives.
2. How does the mission of DFD program align with your agency mission? How does the DFD
program benefit/impact the community?
3. Indicate agency long and short term goals.
4. Identify the agency’s method for goal measurement.
5. Describe the agency’s progress toward achieving administrative goals from the previous year.
Elaborate upon any administrative, programmatic, or fiscal changes from the previous contract
period. If this is a renewal contract, describe at a minimum how has your program developed
and made progress toward its goals in the past year?
6. Describe the Agency’s self-evaluation process and identify the evaluation tools used.
7. Summarize the results of the evaluation from the previous contract period and the changes the
agency implemented in response to the findings. Explain how services are evaluated? What are
the results? Identify strengths and weaknesses noted in evaluations.
8. Provide a brief description of the agency’s most significant accomplishment to date.
9. What barriers, if any, have impacted your agency’s ability to meet program goals?
10. Explain how the agency collaborates and/or networks with other public and private agencies to
serve clients in the community. Elaborate upon agency outreach efforts.
11. Describe the agency’s approach to staff training and development.
12. If fees will be collected from recipients of any services outlined in the Contract Requirements,
state the anticipated annual amount of revenue. Also state how those revenues will be used to
offset the contract’s costs.
24
STATE OF NEW JERSEY
DIVISION OF FAMILY DEVELOPMENT
INDEX OF REQUIRED CONTRACT DOCUMENTS
CONTRACT
NUMBER:
CONTRACT
PERIOD:
CONTRACT
ADMINISTRATOR:
NAME OF
AGENCY:
This index provides details of all required documents that must either be included with the contract package
(see checklist) or must be available on site for inspections as noted in the Document Verification Sheet
(DVS). Forms that are not included in the following pages, can be found by accessing the website at
www.state.nj.us/humanservices/dfd/info and clicking on the link for Standard Contract Documents.
Required
with first
Contract
and as
Amended
Document
Contract Documents
Standard Language Document (SLD) with original signatures
(additional copies requested must also have original signature)
Required
Annually
and as
Amended
Checklist
2
copies
3
copies
3
copies
Annex A (including summary sheet and supporting schedules)
Annex B – Budget Form with all required forms, schedules, and
signatures and required Budget Narrative.
Executive Order 129 (Public Law 2005, Chapter 92) Source
Disclosure Certification Form
Federal Funding Accountability and Transparency Act (FFATA)
Worksheet (if applicable)
Certification of Suspension and Debarment
●
●
●
●
Disclosure of Investment Activities in Iran Form
1.Agreements
Copies of Subcontract/Consultant Agreement(s)
Private/Public Donor Agreement (s) for Match Responsibilities
●
●
●
HIPAA Business Associate Agreement (BAA)
●
A copy of the Acknowledgement of Receipt of the New Jersey State
Policy and Procedures for EEO/AA
2.Insurances/Licenses/Certificates
●
Liability Insurance Declaration Page and/or Malpractice Insurance
●
Bonding Certificate
●
●
Applicable Licenses (business and professional licenses)
Current Affirmative Action Certificate or copy of renewal
application sent to Treasury (AA302 – Affirmative Action
Employee Information Report)
Health/Fire Certificates, Certificate of Occupancy
25
Required
for on-site
Verificati
on - DVS
Form
●
●
Check if
submitted
with
package
Rev. 2013
Page 2
.
Required
with first
Contract
and as
amended
Document
Required
Annually
and as
Amended
Checklist
Required
for on-site
Verificati
on – DVS
Form
●
Lease or Mortgage for Property and Equipment
●
Certificate of Incorporation
New Jersey Business Registration Certificate with the Division of
Revenue (Public Law 2001, Chapter 134)
Documents Required for Non Profit Agencies and as applicable for Profit Agencies
Dated List of Names, Titles, Addresses, and Terms of Board of
S.
Freeholders or Directors
●
●
Copy of the most recently approved Board Minutes
●
Agency By-Laws
●
●
Tax Exempt Certification
●
Form 990 – Return of Organization Exempt From Income Tax
Documents Required for Profit Agencies only
●
U.S. Corporation Income Tax Return, Form 1120
●
Chapter 51/Executive Order 117 Vendor Certification and
Disclosure of Political Contributions (formerly known as Executive
Order 134) and copy of NJ Business Registration Certificate (see
separate link)
biannual
Ownership Disclosure Form (Chapter 51)
biannual
Agency Policies and Organizational Information
●
Organizational Chart
Personnel Manual and Employee Handbook (including job
descriptions of staff)
●
Affirmative Action Policy/Plan
●
Conflict of Interest Policy
●
Procurement Policy
●
Equipment Inventory (contract acquires property with DFD
funds)
Audit
Notification of Licensed Public Accountant (NLPA) - include copy
of Accountant’s Certification (see separate link)
Copy of Single Audit or Independent Audit for recent FY
Other Supporting Documents
Annual Report to Secretary of State
●
●
●
●
26
Check if
submitted
with
package
Annual Report – Charitable Organizations
●
Document
Required
with first
contract
ACH – Credit authorization for automatic deposits (for new requests only)
●
W-9 Form (for new Agencies only)
●
Page 3
Required
Annually
and as
Amended
Required
for on-site
Verificati
on – DVS
Form
Check if
submitted
with
package
Additional Division/Office Specific Forms
Document Verification Sheet (DVS)
●
List of Agency Grants / Contracts
●
Standard Board Resolution (indicating authorized signatories for
contracts)
●
Checklist and Copy of Award Letter
●
Other:
The agency agrees to submit, to the DFD Contract Administrator, any and all changes regarding
the information presented in these documents during the term of the contract. All documents
should be current and reflect the approval of the agency officials, when applicable.
The index is for reference and is not required to be retuned with the contract package. All
documents noted here are either included in the Checklist or Document Verification Sheet (DVS).
The checklist and DVS must be returned with the contract package.
27
DFD OFFICE OF CONTRACT ADMINISTRATION
CONTRACT CHECKLIST
CONTRACT
ADMINISTRATOR:
NAME OF
AGENCY:
CONTRACT
NUMBER:
CONTRACT
PERIOD:
PROVIDER INSTRUCTIONS:
This checklist must be completed and returned with all documents prior to contract approval. The correct
number of copies and any additional Division documents must be returned to your Contract Administrator.
Forms that are not included in the following pages, can be found by accessing the website at
www.state.nj.us/humanservices/dfd/info and clicking on the link to Standard Contract Documents.
Number of
copies to
be
submitted
Document
Complete copy of signed DHS Standard Language
Document (SLD)
Checklist, DVS and Award Letter
Executive Order 129 Source Disclosure
Certification of Suspension or Debarment
Standardized Board Resolution indicating who is
authorized to sign: Contracts and Checks
2
1
1
1
1
Annex A – Parts I and II (including summary sheets,
supporting schedules and LOS).
3
Annex B –Budget Form (Expense Summary, Details
and Schedules 1-6) and required Budget Narrative.
3
List of Grants / Contracts
1
Contract Acquired Equipment Inventory
1
Liability Insurance
1
Bonding Certificate
1
Names, Titles, Addresses and Terms of Board of
Freeholders / Directors
1
Copy of Audit Report
1
Current Affirmative Action Certificate or copy of
renewal application sent to Treasury (AA302)
1
Disclosure In Investment Activities in Form
1
Federal Funding Accountability and Transparency Act
(FFATA) Worksheet (if applicable)
1
Copies of Subcontracts
1
28
Please check if
submitted with
package
If not submitted with
package, indicate anticipated
date of submission or reason
for non-submission
Document
Number of
Copies to
be
submitted
Notification of Licensed Public Accountant (NLPA)
(include copy of Accountant’s Certification)
Private/Public Donor Agreement for Match
Responsibilities
Organization Chart
Conflict of Interest Policy
1
1
1
1
1
Disclosure In Investment Activities in Form
1
As Applicable:
ACH – Credit authorization for automatic deposits
(for new requests only)
W-9 Form (for new providers)
Other:
1
1
1
1
29
Check if data
is submitted
with package
If not submitted, provide date
when document will be provided
NEW JERSEY DEPARTMENT OF HUMAN SERVICES
DIVISION OF FAMILY DEVELOPMENT
DOCUMENT VERIFICATION SHEET (DVS)
Contract Number
Contract Period
The Provider Agency hereby certifies that the following documents are on file and are available to the
Division of Family Development (DFD) for review. The contracting Provider Agency also agrees that it
will inform the DFD contract administrator of any and all changes involving these documents that may
occur during the term of the contract. All documents should be current and reflect board approval.
Please do not submit documents listed below with renewal package.
Please Check as Appropriate
On File
1. Certificate of Incorporation and NJ Business Registration
Certificate (filed with the Division of Revenue)
2. Annual Report to Secretary of State and Ownership
Disclosure Form
3. Annual Report - Charitable Organization
4. Agency By-Laws and Copy of Board Meeting Minutes
5. Business Associate Agreement (unless new provider or revised
agreement)
6. Business and Professional Licenses
7. Personnel Manual and Employee Handbook (including current job
descriptions for staff)
8. Tax Exempt Certification, Copy of Form 990
9. U.S Corporation Income Tax Return, Form 1120
10. Procurement Policy
11. Certificate of Occupancy or Continued Certificate of
Occupancy and Health and Fire Certificates
12. Property Lease/Mortgage and Equipment Leases
13. Affirmative Action Policy and copy and acknowledgment of
NJ State Police Policy on EEO/AA
I hereby certify that all documents are current and are available for review.
Agency Director (Please Print or Type)
Agency Director’s Signature
Agency
Date
30
Not
Applicable
EXECUTIVE ORDER 129 CERTIFICATION
SOURCE DISCLOSURE CERTIFICATION FORM
Bidder:
Solicitation Number:
I hereby certify and say:
I have personal knowledge of the facts set forth herein and am authorized to make this Certification on
behalf of the Bidder.
The Bidder submits this Certification as part of a bid proposal in response to the referenced solicitation
issued by the Division of Purchase and Property, Department of the Treasury, State of New Jersey (the
“Division”), in accordance with the requirements of Executive Order 129, issued by Governor James E.
McGreevy on September 9, 2004 (hereinafter “E.O. No. 129”).
The following is a list of every location where services will be performed by the bidder and all
subcontractors.
Bidder or Subcontractor
Description of Services
Performance Location(s) by
Country
Any changes to the information set forth in this Certification during the term of any contract awarded
under the referenced solicitation or extension thereof will be immediately reported by the Vendor to the
Director, Division of Purchase and Property (the “Director”).
I understand that, after award of a contract to the Bidder, it is determined that the Bidder has shifted
services declared above to be provided within the United States to sources outside the United States,
prior to a written determination by the Director that extraordinary circumstances require the shift of
services or that the failure to shift the services would result in economic hardship to the State of New
Jersey, the Bidder shall be deemed in breach of contract, which contract will be subject to termination
for cause pursuant to Section 3.5b.1 of the Standard Terms and Conditions.
I further understand that this Certification is submitted on behalf of the Bidder in order to induce the
Division to accept a bid proposal, with knowledge that the Division is relying upon the truth of the
statements contained herein.
I certify that, to the best of my knowledge and belief, the foregoing statements by me are true. I am
aware that if any of the statements are willfully false, I am subject to punishment.
Bidder:
Name of Organization or Entity
By:
Print Name:
Title:
Date:
31
New Jersey Department of Human Services
Division of Family Development
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions
1.
The prospective lower tier participant certifies, by submission of this proposal, that neither it nor
its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by an Federal or State department or agency.
2.
Where the prospective lower tier participant is unable to certify to any of the statements in this
certification, such prospective participant shall attach an explanation to this proposal.
Name and Title of Agency Official __________________________________
Signature _________________________
Date _____________________________
This certification is required by the regulations implementing Executive order 12549, Debarment and
Suspension, 29 CFR Part 98, Section 98.510
32
STATE OF NEW JERSEY
DIVISION OF FAMILY DEVELOPMENT
STANDARDIZED BOARD RESOLUTION FORM – page 1 of 2
Supporting Information for Contract #:
Contract Period:
to
Agency:
Certification:
We certify that the information contained in, or attached to, this contract document is accurate and
complete.
__________________________________
Chair, Board of Directors
(Original signature)
________________________
Date
__________________________________
Executive Director
(Original signature)
________________________
Date
Please List Authorized Signatories for contract documents, checks, and invoices:
(List full name and title)
Name
Title
Name
Title
Name
Title
33
STANDARDIZED BOARD RESOLUTION FORM – page 2 of 2
The Board endorses the following commitments as defined in this document:
1. Health Insurance Portability and Accountability Act (HIPAA)*
Specific to HIPAA (Health Insurance Portability and Accountability Act), the above noted
Provider Agency is deemed a covered entity and must submit the required Business Associate
Agreement.
Once executed, the BAA will be included in the Department’s official contract file. The BAA
will be considered applicable for this contract. Any changes in the Provider Agency’s status,
information or the content of the BAA, is the responsibility of the contracted Provider Agency to
revise the BAA.
The Board agrees to notify the Department of any change in its BAA Status and provide the
appropriate information within 10 business days.
2. Legal Advice
The Board acknowledges that the Division of Family Development does not and will not provide
legal advice regarding the contract or any facet of its relationship with the Provider Agency. The
Board further acknowledges that any and all legal advice must be sought from the Provider
Agency's own attorneys and not from the Division of Family Development.
3. Public Law 2005, Chapter 51
The Board agrees that the Public Law 2005, Chapter 51 (formerly known as Executive Order
134) compliance forms submitted with the contract is accurate.
4. Public Law 2005, Chapter 92
The Board agrees that the Public Law 2005, Chapter 92 (formerly known as Executive Order
#129) compliance forms submitted with the contract are accurate.
34
STATE OF NEW JERSEY
DIVISION OF FAMILY DEVELOPMENT
List of Contracts/Grants
Check here if this information already appears on the Annex B, Schedule 2 - Contract
Information Form. If so, then it is not necessary to duplicate the information here.
Contracting
Division/Office
Program
Name
Type
of
Service
Contract
Number
Contract
Term
35
Amount
Division/Office
Contact
Person and
Phone
Number
Provider Agency
Contact Person
and Phone
Number
CONTRACT FORMS
Available at the DFD website:
AA 302
Federal Financial Accountability Transparency Act (FFATA) Worksheet
Notification of Licensed Public Accountant
Disclosure of Investment Activities in Iran
36
FY 14 and FY 15 Federal Award Information
TANF: (SSH, TS)
Funding from the Department of Health and Human Services, Administration for Children and
Families under the Temporary Assistance for Needy Families
FY 16 - Grant Number G-1602NJTANF and the CFDA Number 93.558
FY 17 - Grant Number G-1702NJTANF and the CFDA Number 93.558
CCDF:
Funding from the Department of Health and Human Services, Administration for Children
and Families under the Childcare Development Funding
FY 16:
Grant Number 2016G996005
Grant Number 2016G999004
Grant Number 2016G999005
CFDA Number 93.575 Discretionary Contract
CFDA Number 93.596 Mandatory
CFDA Number 93.596 Matching
Grant Number 2017G996005
Grant Number 2017G999004
Grant Number 2017G999005
CFDA Number 93.575 Discretionary Contract
CFDA Number 93.596 Mandatory
CFDA Number 93.596 Matching
FY 17:
37